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Premature death rate in Ontario has dropped, but not in every region: study

Last Updated Feb 28, 2018 at 12:46 pm EDT

A doctor working in a hospital. REX FEATURES

More people in Ontario are living past the age of 75, a new public health study has found, but the gains in longevity are seen mostly around the Greater Toronto Area.

The Ontario Atlas of Adult Mortality, released last week, found the premature mortality rate — deaths before the age of 75 — declined by about 20 per cent between 1992 and 2015.

But the research team, led by Laura Rosella of the University of Toronto’s Dalla Lana School of Public Health, found that not every part of province, which is divided into 14 geographic areas directed by a Local Health Integration Network, or LHINs, saw the same level of improvement.

“What could be happening is the benefits that we know reduce mortality aren’t reaching the populations they need to in a timely way,” Rosella said, explaining that premature deaths are often ones that could have been avoided through treatment or preventive measures.

“We also know there’s complex social and demographic differences across the province, which contribute to mortality.”

The Toronto Central, Mississauga-Halton and Central LHINs, all in and around the Greater Toronto Area, saw premature death rates decline by around a third. But the Southeast, Southwest and Hamilton-Niagara-Haldimand-Brant LHINs saw only half that improvement, while certain demographics saw next to no change or even an increase in premature death rates.

In 1992 the Toronto Central LHIN saw more than five premature deaths per 1,000 residents among men and three premature deaths per 1,000 among women. By 2015, those figures had dropped to just over three per 1,000 residents for men and under two per 1,000 residents for women.

By contrast, the Northeast LHIN, which covers 400,000 square kilometres from the Ontario-Quebec border to the north shore of Lake Superior, and Hudson’s Bay to Lake Huron, had seven male deaths per 1,000 residents and about 3.8  female deaths per 1,000 residents in 1992. In 2015, the premature death rate for men had dropped slightly, to over six deaths per 1,000 residents, while the female rate had actually increased, to approximately 4.3  deaths per 1,000 people.

The percentage of Indigenous people in the Northeast LHIN’s population is more than double that of Canada as a whole.

The Ontario Ministry of Health says it has taken steps to ensure equal access to health care across the province, but acknowledges more work remains to be done.

“Ontario is investing nearly $222 million over the next three years to ensure Indigenous people have access to more culturally appropriate care and improved outcomes, focusing on the North where there are significant gaps in health services,” said Laura Gallant, spokeswoman for Minister of Health and Long-Term Care Helena Jaczek.

“This investment will be followed by sustained funding of $104.5 million annually to address health inequities and improve access to culturally appropriate health services over the long term.”

The mortality atlas revealed that the northern and outer southern regions of Ontario had higher percentages of smokers, heavy drinkers and overweight or obese people between 2000 and 2010 compared with the central parts of the province.

Changes to industry and a widespread loss of employment could also have played a role in the relatively low improvements in southwestern and southeastern Ontario, Rosella said.

Premature death rates in all parts of the province were significantly higher for people in the lowest income bracket, who earned an average of $16,000 a year in 2010, compared with those in the highest bracket, which averaged $85,500 a year the same year. However, the researchers found the relationship between socioeconomic status and premature death “varies dramatically” from one region to another.

“For example, being in the most deprived area in the Toronto Central LHIN is still better off than being in the best area in other (outer) regions of the province,” Rosella said.

“This tells us that socioeconomic disadvantage isn’t the end all, be all (for health),” she said. “It may be that in certain parts of the province there are more supports, more safety nets in place so that there are mechanisms in place to blunt the impact.”

The researchers’ hope is that the people who lead Ontario’s health-care system can try to close the gaps between the different regions.

A steering committee, which helped direct the research, includes Ontario government officials, LHIN representatives, and leaders from several health-care associations, including Cancer Care Ontario and the Provincial Council for Maternal and Child Health.

“We really wanted to put this on the table (to show) this is what’s happening, so that the health system and policy makers in the province can respond and say, ‘Why is this happening and what can we do about it?'” Rosella said.